Seizure anticipation: Are neurophenomenological approaches able to detect preictal symptoms? Claire Petitmengin a,b, * , Michel Baulac c,d , Vincent Navarro c,e a Groupe des E ´ coles de Te ´le ´communications, GET/INT, Paris, France b Centre de Recherche en E ´ piste ´mologie Applique ´e, Paris, France c Epilepsy Unit, Pitie ´-Salpe ˆtrie `re Hospital, Paris, France d Cortex and Epilepsy, INSERM U739, Pitie ´-Salpe ˆtrie `re Hospital, Paris, France e Cognitive Neurosciences and Brain Imaging, LENA, CNRS UPR 640, Pitie ´-Salpe ˆtrie `re Hospital, Paris, France Received 20 December 2005; revised 3 April 2006; accepted 29 May 2006 Available online 24 July 2006 Abstract Analysis of electroencephalographic signals and several brain imaging studies suggest that a preictal state precedes the onset of sei- zures. In this study, we used phenomenological strategies to detect modifications in patients’ experience before their seizures. We observed that patients with partial epilepsy feeling an aura (n = 9) frequently experienced prodromes (n = 6). Prodromes were subtle pre- ictal symptoms, varying among patients and having common negative features. They were generally continuous before seizures and could last hours, whereas auras were sudden and intermittent. All patients were able to recognize facilitating factors. We also found that patients spontaneously develop cognitive countermeasures to avoid facilitating factors (n = 6), to prevent a seizure (n = 1) or to interrupt a seizure (n = 5). Prodromes are not specific enough for clinical use, but could refine the behavioral strategies used in the treatment of epilepsy and the pathophysiology of the preictal state. Ó 2006 Elsevier Inc. All rights reserved. Keywords: Neurophenomenology; Phenomenology; Epilepsy; Seizure anticipation; Seizure prediction; Aura; Prodrome; Control of epileptic seizures; Behavioral treatment of epilepsy 1. Introduction The unpredictable nature of seizures leads to permanent insecurity for patients with epilepsy and their families, and is the main cause of their altered quality of life. Despite impor- tant progress in the understanding of the cellular mechanisms of epilepsy and in the localization of the epileptogenic focus, the pathophysiology of seizure emergence remains unclear. Analysis of the electroencephalographic signal using mathematical methods suggests that it is possible to detect a preictal state in electroencephalographic dynamics before seizure onset [1–5]. In particular, phase synchrony analysis has revealed a decrease in synchrony between brain areas surrounding the epileptogenic focus before seizures, underlining the role of dysfunctioning networks in partial epilepsy. A few functional brain imaging studies, using sin- gle-photon emission computed tomography (SPECT), functional magnetic resonance imaging (fMRI), or an intracranial thermal probe, have also identified modifica- tions of local cerebral blood flow before seizures. However, these methods are not specific enough for current clinical application. In addition, they do not explain the underlying abnormalities. Finally, these strategies indicate the brain structure, but not the nature of the preictal phenomena. Complementary approaches are therefore needed to acquire additional insights into the preictal period. Concerning the patient’s lived experience, the phenomeno- logical aspect, some patients report subjective symptoms www.elsevier.com/locate/yebeh Epilepsy & Behavior 9 (2006) 298–306 1525-5050/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2006.05.013 * Corresponding author. Present address: 9, rue Charles Fourier, 91011 Evry, France. Fax: +33 01 60 76 44 93. E-mail address: Claire.Petitmengin@int-evry.fr (C. Petitmengin).